will not be taken seriously outside. speaking american, as well, there is a perception that it is a serious international institution and it leads americans. the actual architecture of the and the attitude that the government and the intelligence itncies have taken to that, is now no longer given, u.s. dominance of the internet. something is going to have to give there. it may still be true, or if they can work out how to go for multilateral, something that actually works and protects what is good about the internet.

it could go quite a bad direction. theould be a shame if resulting exposure of the u.s. abusing its -- allowing other states to start abusing newfound powers of the internet. i think that is the opposite direction we want, but it isn't a given yet. a large degree of what happens next depends on the u.s. response. >> i think we are out of time. let's give a hand to our panelists. [applause] they will be signing books in the next room over here, and thanks, everybody, for coming.

[captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute] >> coming up tonight, remembering former first lady rosalynn carter. it begins at nine eastern. >> we focus on the issues you expect in the tech industry. we want to make sure that innovation is a national strategy. .e dominate in so many areas it is a global -- global phenomenon. the u.s. is the world leader, and we want to keep it that way which requires great immigration

policies. it requires additional spectrum. you could invent things but you are not being seen by -- being sued by everyone all the time for ambiguous patents. >> gary shapiro, tonight on the at 8 p.m. eastern on c-span2. but the deadline is approaching for c-span student cam video competition, open to middle and high school students, answering the question, what is the most important issue congress should address this year? that includestary c-span programming. there's 100,000 dollars in total prizes with the grand prize of $5,000. injuries are due by january 20. -- entries are due by january 20. is back from winter recess today, kicking off its 2014 session with a vote on whether to approve janet yellen as the first woman to approve the that oral reserve. she has been as chair of the fed

since 2010. the vote is set for 5:30 eastern, about an hour and a half from now, which you can see live on c-span2. -- they arejohnson required to obtain coverage through the new health care law state exchanges. the wisconsin republican filed a suit today in u.s. district ,ourt in green bay, wisconsin saying the lawsuit is about ensuring congress received no special treatment. a discussion now on implementing the affordable care act. washington journal talk to reporters covering the issues were about 45 minutes. >> thanks for being with us. through how it has been going. >> the rollout of healthcare.gov

do not help anything. some are going to the doctors office and that is fine, they're using their new obamacare coverage. problemse encountering when they try to get a prescription filled or when they called to get answers. sake sake -- take several months for this all to shake out, and for all the different providers to adjust to the affordable care act in all of the locations. there's a lot of shake up right now and nobody really expected it to go perfectly smoothly in the first few weeks. the administration is telling people to first and foremost call their insurance companies because those are the people who are likely to happy answers. as many people have been rolled in obamacare plans are just learning about their plans for the first time in the last two weeks. is complicated,

so there are people who are having to go and follow up with these companies, with these providers to make sure they know what is going on. set up aistration also toll-free number and has agents to help people navigate the and open file with caseworkers to help people with persistent issues. >> i understand are still other deadlines looming. >> january's very interesting people -- very interesting. people still don't need to have paid for the coverage to begin on january 1. summary using covers they have not paid for. we will be watching that. many opponents of the affordable care act illegally should not be and open filecounting the 2.1 e who have enrolled in private plans as currently enrolled because not many of them have paid their first premiums yet, so we will -- will be looking at that. then we have the march 31 deadline that inns the official six-month enrollment. . we will be watching how many people are enrolled in private

stable are the risk pools, is going to be the question going forward. talk us through what you're republicans in who are obviously very focused on the law. >> they are ready planning another obama related -- they will be voting related to there is ancerns, bill proposed that would require the administration to notify anyone whose personal data was compromised as a result of healthcare.gov's security issues.

the republicans are going to try to draw attention to that as a way to undercut the law, start thely as we election season, the republicans are looking to make this their main issue. >> it was reported that the news would use of aca increase. explain what that means. >> people were not able to use their new obamacare plans until january 1 at the earliest. as we know, people that use health insurance from day one. you might not need to go to the doctor or fill a prescription. what health care providers have beginning tole are use the insurance plans starting this week, obviously the holiday lag has gone away, people are back at work, back in their normal lives, so they will be

calling their doctors and getting some of these needs met at the beginning of the year. >> the first call comes from new jersey. henry is on the line for democrats. henry, are you with us? go ahead. you?od morning, how are first-time caller. down your tb, we will be happy to chat with you. i am toe say how happy be a part of this obamacare. my wife and i go -- both got laid off at a i am to be a part of this job, they downsized us. she had no insurance for a while. cobra costs us like $800 apiece, sign up and i would keep on every day, every hour. i did not have much problem.

i wish people would go into the system and see how it works. she had no insurance for a while. i'm living proof of how well obamacare works. my wife got sick a couple of days ago and we were praying that we didn't get sick before we got insurance. she went to the doctor. we don't have the card yet. everything was in the computer. cvs the drugstore, the prescription cost seven dollars. i wish everybody would look into it and give it a fair shake it is the way these people are talking about it is unfair. ain't you. certainly has a success story, he and his wife for the kind of people the administration hoped to help, people who have lost their jobs and are paying for insurance on

the individual market. it is possible that family is receiving a tax credit to make the coverage more affordable. in the state of new jersey we havei'm living proof of how well obamacare works. seen people reporting positive experiences. it is important for viewers to remember that this law affects every american in a completely different way. one of the reasons the narrative has been so negative is that any agative story is going to be rebuttal, they will talk about it as if it is an attack on the law. whoe are people like henry are happy with it. >> west virginia, george is on the line for democrats. s forod morning, and thank c-span. i don't think this young lady is telling the real truth about obama care because i don't think she belongs in it. do you belong in obamacare? do you have obama care? >> i have employer-based

insurance, but i know a lot about obama care. do you have a question? to westhould come virginia and see how many people try to get care in they cannot even get a telephone call to go itthrough. that, you're not going to get the 7 million people plus to make this thing work, for one thing. and then the emergency room has quadrupled already with people going to the emergency room, because they cannot get into obamacare. you put them into that medicare thing. triple people going to the emergency room, so where are you saving money? you are spending more money of these people that didn't have insurance, that didn't want to buy insurance, and you people are giving it to them now for practically nothing. that is why they're happy for

it. i've always had good insurance, and i paid for it out of my pocket. not only that, i am a veteran also, but this obama care is going to self-destruct. the republicans don't have to do one thing to get rid of it. it's going to self-destruct itself. mark my words, within the next year. obviously there have been many problems with obama care across the country. people's experiences tend to be mixed based on what state they live in. people in west virginia where i believe the caller is from have been having many problems. that doesn't surprise anyone in washington am a particularly opponents of the affordable care act. do you have any idea how on pace they are to make the benchmark? that 2.1ember we know million people have signed up on federal plants on both federal and state exchanges.

it was a major expansion based on what we saw in october and november, the very troubled months at the beginning of the enrollment. . i think the administration still has some catching up to do to reach that 7 million benchmark. the white house has pushed back and said 7 million was not really their goal. marketplaceean the will not survive with fewer enrollees. >> let's go to fairfax virginia. grant is on the line for democrats. i just wanted to say that obviously there are a lot of problems with obamacare, she is right about that. everybody knew that was going to happen, and health care is very complicated. unfortunately, the insurance companies are still really in power, although there are some steps to improve conditions and

things like that. but we need single-payer. that is what we need. i'm so tired of the republicans -- they justall want to keep rings the same. we have to move in some direction. we have to try something. son who had what is called baby asthma, which is fairly common. usually they outgrow it, it just kind of goes away. after he was diagnosed with that under two years of age, the insurance company sent me a letter saying they would no longer cover anything having to do with his entire respiratory system from then on. that is the kind of crap that has been going on. the health of a human being should not be something for someone to make a profit on.

>> from any liberal progressive democrats, the law did not go -- enough to visit maintains we have to remember that these marketplaces are all about connecting uninsured americans with private health insurance. it is heavily regulated but it still remains in the hands of private insurers. there are many families out there who are thankful for the affordable care act because it bans discrimination based on pre-existing conditions, which could've been something as minor as baby asthma, but for other people it could be apnea or sleep apnea. believee things many people should not be have been for, andated against the affordable care act does not let that happen. >> do you expect to see more of that? >> i think there will be other delays in the coming months, perhaps before the end of march, as the administration seeks to reach as many potential enrollees as possible.

possible that the six-month enrollment could be delayed. the march 31 deadline could be pushed back and the payment deadlines could be pushed back. i think insurance companies will be receiving more money from the federal government in order to shore up the risk pool, which may not be as stable as the administration hoped. because ofble problems with healthcare.gov that people who would otherwise have qualified for the medicaid expansion who live in states where was not implemented. it is working better. tech surge is what the white house called it, in order to fix the website. onwas not working well october 1. i remember being here at c-span2 talk about it and i had gone on that morning and it was clearly not working well from the into ang, which turned enormous political firestorm for the white house that lasted a month. now it is working better and people believe it has turned the corner.

isormer microsoft executive a replacement. the administration is very focused on making sure the website works going forward because it was such a disaster starting on october 1. frank is on the line for republicans. this is a tax that people have to pay to stay in the country now. it used to be you don't have to buy insurance to stay in the country or get a fine or whatever, but now this is a tax you have to pay to actually stay in this country or you will get fined. insurancehave to have in any other -- now you're forced to buy it. and it is not affordable. problem, they should start with the hospitals,

the doctors, and the insurance companies. they charge too much. $45 for an aspirin if you go to the hospital. i went to the hospital for a toothache. they told me they couldn't help me, they are not equipped. they charged the $4700. guest: the caller brings up an important point, which is price inflation. if you go to the hospital, their medications, including something as simple as an aspirin, will cost you a lot more than it would if you get it at the local drugstore. if you compare hospitals in new , ak -- in your hometown procedure may cost three or four times as much at one as a few miles down the road. we need more transparency about the prices so people can make choices that are better for them. often when we need to get health

care needs met, we are not thinking about the prices and many wish those were out there in the public. >> i have a couple of questions, very easy. the first question is, are we headed for universal health care ? variouswhy was the eight insurance departments not involved in the process prior to the affordable health care? my third question is, do you magi?anything about ohio's possibility there a that our politicians can regulate the hospital billing practices and let us know how much we are charged for various services?

thank you so much. >> i will just run down the line with some of your questions. some believe obama care represents a movement toward universal health care. everyone is now required to have insurance or pay a fine. you can get it through private insurance, it depends on how you define universal health care but certainly it is a law that attempts to achieve that in a variety of ways. some of them are working heavily with the federal government in order to implement this law. others have not been as involved. magi issue in ohio is something i'm not particularly aware of because i cover the federal government, but i would encourage her to reach out to her insurer in ohio who would be able to answer that question. the third about regulating

hospital billing practices, that is the issue i was talking about earlier. the public desires transparency when it comes to pricing of medical care. >> let's go to j in connecticut on the line for democrats. thatwould like to mention over three years ago i was involved in a car accident. work andck to reentered the foot that i had injured in a car accident. health care in 2012, we put out almost $20,000 in health care between the co-pay and paying the insurance direct. i put out somewhere, not sure exactly, between 17,000 and $18,000. on the limited income that we got, that was 67% of our income.

we have paid our savings out of the ira to supplement this year. my wife is not -- in the process of getting on obamacare. insurance has changed drastically, slow down, stop. this could happen to anybody. you could be hit head-on with a car. life changes in a fraction of a second. you do not know what is going to happen tomorrow. thank you for your time. guest: any american, any person can run into an unexpected health crisis, as the caller

said, which is why many people feel that health insurance is so important, it prevents the kind of medical threat, but even if you have health insurance you are sometimes overloaded with terribly onerous out-of-pocket costs. host: you recently wrote a post called "top five obamacare stories to watch." guest: we are watching enrollment numbers very carefully. they are going to suggest how successful it is likely to be in the future. we know the 2.1 million people signed up for health insurance plans through healthcare.gov in december. said, which is why many people obviously the administration wants that number to be much higher by the end of march. we will be watching that. but what we really want to know is the age of the people signing up for the health-care exchanges, which the administration has not said they will not publish the data, but they certainly have not put it

out yet. this is a concept of insurance that if you have enough young people do not subsidize the cost of your sick or patients, it will move altogether. out yet. this is a concept of insurance if you do not have that, if it is only 60 people signing up, the administration could be in trouble, so we will be watching it. there are many strategies in the pools that are not in good shape. it is not that all is lost if it is older or sicker people enrolled, but we will be watching as it will be a problem for the white house of that is the case. host: scarborough, maine, republican line. caller: good morning. guest: hi. caller: do you suspect, now, that everyone going to the hospital and to the doctor has insurance? i know that in the past people would go to the emergency room because that was their only outlet. that was our most expensive place for them to go. now that everyone has health insurance, instead of the

hospital billing out 69 dollars for a band aid, it is now $.69. that may be the wrong number, but i think that got paid out to insurance companies who wound up paying to the hospital that amount of money. someone had that much money. do you suspect that now all of that is going to drop? and the immigrants that are not undocumented people, they are going to end up in the emergency room. who pays that bill? thank you. guest: these are great questions for emergency rooms and health care for the uninsured. they are the most expensive venue by far, barring certain surgical operations, emergency room's are very expensive. the caller is right, they looked at uncompensated care for the uninsured, particularly low income americans in underserved communities, there are billions

of dollars effectively donated to charity in the form of care for the uninsured. it is likely that health care prices in some areas could go down as a result, people having insurance, it could be better for everyone overall. it is an interesting question, going forward. host: baltimore, maryland, michael is on the independent line. caller: thank you for taking my call. i was just wondering, with the affordable care act, what about the new taxes that will be implemented along with it? who, primarily, will be affected? thank you. guest: these are great questions. the affordable care act pays for itself with new taxes on health care industry. new taxes on providers. very few americans will be

seeing these taxes, although there are a few that will hit people. many people point out that the individual mandate to buy insurance or pay a fine, if it is upheld as a tax, but primarily the law pays for itself through a variety of taxes on the health-insurance industry, like medical device manufacturers. host: what is happening with the birth control mandate? host: --guest: from the beginning that has been one of the most controversial portions, offering a range within health insurance plans. for celtic -- secular employer, that is not a big deal, many of them were already offering birth-control ranges. but for secular companies with religious owners, this has become highly controversial. there are certainly states that preach against this control, particularly the morning-after pill, which some people consider equal to abortion.

picking up the mandate in the coming years, recently sony a soda mayor issued an injunction for a group of catholic nuns in denver, which made major news, as it had not been done before. even under the accommodation proposed by the white house, it was deemed that their religious liberty was still being infringed. no one is quite sure how it will come down, but we are watching. host: from twitter this morning explain why it is so expensive. guest: so expensive? oh, boy. obviously provides a variety of tax credits to americans, expands medicaid, pays for major expansion of health care in the united states through taxes on the insurance industry. it is one of the largest federal laws of its kind we have seen in decades. that may be why it is so expensive.

host: independent line, raleigh, north carolina. caller: yes. my question is -- the administration has said that it is on the younger generation to sign up and pay for the healthier. if the healthier are allowed to stay on to their parents insurance until they are 26, it cuts them short, they will not be paying for it until after they get off their parents insurance. how is the affordable care act supposed to be paid for? thank you. guest: when you talk about younger, healthier people signing up for obamacare, we are not just talking about teenagers, we are talking about people in their late 20s, early 30s, into their 20's on the affordable care act. many people out there, those are

the people the administration hopes to sign up for the new exchanges. host: gary is on the line for democrats. caller: why is it, if you had a doctor, the wonder -- the one doing the service, and then you had the insurance company, the one handling the money and the paperwork, and the government involved, why do you need all of these people involved? especially the insurance companies. people went up three percent to five percent. plus, the irs is going to collect the money for the insurance companies and handle it. it seems to me like this is a fallback so that if the federal reserve bails, then they have

another income on the people that saves income tax. it is a monopoly. guest: interesting point. the affordable care act does regulate much of the industry. it was negotiated in washington who know that at the result it would receive many more customers in exchange for the tax. host: you mentioned the tax breaks of the health-care website. you expect to see more guest: guest: in the near future? absolutely. the house gop will vote on a measure related to the security of the website requiring the administration to notify consumers it a to has been breached on the website, which has not happened yet that we know of.

security of the website has been a major issue for many in congress. darrell issa has been focused on it very closely. i think americans are concerned about the security of many retailers including health care. with breaches of snap tab and target in these different places, we can ask act to see more of these attacks which will turn more questions to the health-care website. host: what about those trying to defund it? guest: i think house republicans will be interested in keeping as much focus as possible on this. they feel this is an issue double-click the candidates to victory in 2014. certainly we can expect many more votes on the issue.

host: don and michigan on the line for republicans. caller: good morning. you mentioned about taxes, and i own insurance agency in michigan. you said there were no taxes at the rates of the affordable care act. this is the biggest tax hike on the middle class in this country's history. just a family of four with a silver plan, average age, about $118.84 per month just in taxes. can you explain to the audience on how you said there is no taxes for obama care? guest: the caller is mistaken. there are taxes on individuals. primarily it is paid for are the health insurance industry.

certainly many people will see their out-of-pocket cost rise. others will see them fall. there is no way to argue there are no taxes in this law. host: cynthia on the line for democrats. caller: hello. i was calling to comment on another callers comment from west virginia. i have a 23-year-old son that ran into the hospital. he was able to get in. he actually signed up for the obamacare at the hospital, which he said was very nice. there were not any problems. a lot of what people say about obamacare has been factual because i experience it where there were not many problems.

guest: many people are having positive experiences and signing up in their local communities at public agencies and having a fine time. it kind of depends which state you live in. it sounds like this woman's son had a good experience. host: mark stone writes -- guest: yes. that is a very interesting question and very complicated for people's income who tends to vary. seasonal worker -- workers and part-time workers will find it difficult to navigate the issue of subsidies. the government will pay the full subsidy to the insurance company on your behalf if your current income makes you qualified for it. in the next tax year they will have to address and perhaps repay some of the subsidy. it will be very complicated and an issue that will come up next

year when the first filing season happens after obamacare is implemented. host: align -- a caller from ohio, and independent. caller: i was diagnosed 18 months ago with: cancer. i am 55 years old and did not have insurance. by the end of last year i had racked up 300,000-$500,000 in medical bills. i have to have chemo every two weeks to stay alive. this new affordable care act has been a blessing to me and my family. i was wondering -- the caller may have answered this a long time ago, but nationwide health insurance seems like eventually it will have to go that way. it is so expensive to coverage coverage it on an individual basis. guest: certainly something the progressive democrats are hoping for.

that we will move more towards a single-payer system. it seems like the american public is wary of this. after the affordable care act rollout the law remains very controversial. the majority purported they are still having bad experiences under the law. seems unlikely the public will tolerate a major overhaul of the health care system within years. we will move in that direction of the republican party not likely to let that happen. they are still intent on repealing that law. host: let's talk about cancellation notice -- notices. do you expect to see more of them? guest: it has created an enormous political fire for the white house over the past couple of months. many plants did not comply with regulations and had to be canceled.

that also means they did not qualify for grandfathered status under the law. this became an issue for republicans, citing that president obama promised several times for people to keep coverage if they liked it, and that turned out not to be true. we will see that echoed over the next year. i think it is possible that employers will begin shifting some employees onto the new health-care exchanges over time. it is possible we will not see that movement for the next several years. there are cancellation notices in some people's future. many will say that is one reason we are happy that the marketplaces exist. host: jen on the line for republicans. caller: i am a word person. i have heard many people report that the pay will come from the

government. the health-care care industry will pay extra taxes. the central pay person is me and you. it is taxpayers. i think c-span and your reporter would do us a service if you spearheaded the idea that taxpayers pay all the bills. the government does not have any money come except what they take from us. you are leaving out the fact that the health-care industry does not prime -- print money. they only take money for fees and services. the taxpayers are paying for the whole thing. no government agency, no industry except for they get it from us. i wish all the networks and reporters would tell the truth like it is.

some people who are ill informed will think the government is taking, great. we are the government. guest: we have to remember that individuals are taxed and that creates government revenue to do what they need to do but taxes on individuals are not the only type of taxes. industries are taxed, companies are taxed and that is major revenue streams. the caller is correct in some sense that people will see some higher taxes on the affordable care act, or at least higher prices but many come from higher taxes on companies. perhaps people want to argue the taxes are raising prices for consumers, which could be the case. it is incorrect to say it is the tax on individual people that is paying for the affordable care act.

guest: another question on twitter -- guest: currently that is not a practice in american medicine. keep all are very upset about this. consumer -- consumers desire transparency when they use medical services. it is frankly in the service of the health-care industry and one way or another for them to keep that less public. the obama administration will move forward with a variety of initiatives that would allow the consumers to understand the pricing of the health-care. over the past year they published a report about the cost of hospitals using data mined from medicare. that shows based on the geographic area you could pay for times more or quite a bit less for the same medical service. perhaps congress will get in bald -- involved on that.

caller: i am a retired nurse. i was formally elected to be president of the chicago nurses association and work day and -- worked 10 years for the visiting nurse association and a very familiar with the health-care problems of this country. i believe it is imperative that we have a reform so that more people have greater access to health care. if we look at the vital statistics in the health-care system, we are not the leaders of this world. that is unforgivable as we choose to use the technology for unrelated matters. i am 100% behind president obama and michelle obama for their views about our health care needs in the health care system

and to think the glitch that happened with obama's proposal was not entirely accidental come a republicans have shown themselves to be thinly disguised, greedy people. guest: that is interesting. the caller raises the fact that health care outcomes in the united states are not as good as other countries. that is an important point. it is not discussed widely among the american public that in the united states your health care outcomes are not likely to be as good as they are in other countries, despite the fact that that we -- despite the fact that we pay more for our health care. that is something people want to see performed. host: howard in florida on the line for independents. caller: good morning. your guest seems to be a great plan of the obamacare plan but it is simply a ponzi scheme that

will not last. 6 million plus policies have been canceled, approximately 20 million will. so far i have heard 500,000 have actually paid for a plan. that is a scheme that can last. obviously there will be a massive company bailout. the cure is worse than the problem. no amount of spin, lies, and deception will change that fact. it is only a matter of time before the whole thing crumbles. forget the spin. reality is a fraud. guest: that is certainly a precise view of the affordable care act. for myself, i am a neutral reporter, and that is why i am here talking about the facts.

others are not benefiting as much. this is where i -- we see the attention. that is why it remains unpopular in many parts of the public. host: thank you for joining us. >> tomorrow, president of the american principles project, abouts cannon, we'll talk social conservatives priorities and agenda in congress this year, followed by look at federal investment in green technology companies. discussion on al qaeda and affiliate troops in iraq and the u.s. agreement to assist without sending in troops. see washington journal every morning at 7 a.m. eastern here on c-span.

>> our message was this. as mothers, we are concerned. as first ladies, we are committed. and as citizens of the world, we pledge to do all possible to stop this scourge. >> however different we may appear, there is far more that unites us than divides us, and we are here to find common ground, so that we may help bring new dignity and respect to women and girls all over the world. you are such a vital part of that very conversation, because in the coming years, all of you will be building the businesses. you will be making the discoveries and drafting the laws and policies that will move worlduntry and our forward for decades to come. >> monday, starting january 13, our original series, first

ladies, influence and image, returns with the five most recent first ladies, from nancy reagan through michelle obama. monday at 9:00 eastern, live on c-span and c-span3. also on c-span radio and www.c- span.org. quick north carolina representative mel watts was housing to lead the finance agency. he was officially sworn in earlier in the day. we are looking live here at the capitol where the senate is in session and will take a couple of votes shortly. one on whether to approve janet yellen as the chairman of the federal reserve. she would be the first woman to hold the position. that vote is set or five: 30 eastern time, about 40 minutes from now. then there will be a second vote

on extending unemployment benefits for the long-term unemployed. politico writing that the fate of the bill hung in the balance today as senate democrats desperately sought republican votes ahead of an evening roll call. the senate democrats believe their entire 55 member caucus will support the legislation, -- senate democrats believe that susan collins of maine and lucy makowski of alaska will support the legislation. say that aoes on to handful of census republicans have yet to announce their positions, leaving a possibility that democrats could find the requisite 60 votes. bonus happening in about an hour from now on the senate floor. .ou can see it live on c-span2 of theony was part

soviet union until it became an independent country in 1991. ia was part of the soviet union. from the center for strategic and international studies, this is an hour. >> good morning, ladies and gentlemen. thank you for making it over to see sis. i direct the international security program. i'm not have a connolly, who is listed after program. heather was trapped in florida, of all places, by canceled flights yesterday. the good news is she ended up in a place with the warmest weather in the u.s.. the bad news is there are no flights going there, so she couldn't get out. leisure ofdistinct introducing the minister of

defense of the republic of estonia. he has been a member of the estonian parliament since 2003. prior to 2000 three, he was a lecturer at the academy of security studies and has held a number of positions advising the estonian government. we are triplets to have him here today to discuss estonia's military modernization plans ahead of the september 2014 nato summit. after his remarks, we will discuss some of the issues most relevant to estonia's defense, then we will open up the session to questions from the audience. so please join me in a round of applause for the minister. [applause] >> thank you very much for warm, welcoming words. i am coming from the nordic country where we are having an

exceptional situation. we do not have snow. i am delighted to be here and i am very proud that among us are to helicopter pilots from estonia's air forces, who have served in afghanistan with you and now serve in the maryland national guard. i welcome you here. we will mark a number of important --. anniversaires. 100 years since sarajevo and outbreak of world war i, 70 years since normandy, 65 years since the washington treaty was signed. a quarter of a century since the

berlin wall fell and 15, 10, and five years since the cold war enlargements. it is a moment for us to look back at what we have achieved. nato, along with the european union, was a natural choice for estonia after regaining independence in 1991. membership in western organizations is seen as the coppola of estonian security. this was a great engine for reform back in the 1990's. last year, 76% of estonians supported them are sure. 58% of the population believed that defense forces should participate in international military operations when they can. i am proud to say that all the

time it has been, it has been a consensus vote in parliament. the cause of our history, people remember, because of our history, people remember that peace and security do not come free. we should not forget that we still need to maintain our defense capabilities and contribute to their lives. there have been discussions about nato's role, but we must keep in mind what has been achieved. with the end of the cold war, global security environment changed almost overnight.

nato adapted to it. throughout the period of the cold war, nato forces were not involved in a single military engagement. since that time, they have engaged in missions that cover the spectrum of crisis management. today, just under 100,000 military personnel are engaged in nato missions around the world. nato continues to provide multinational command structure capabilities. it is the most powerful military alliance in the world. it hasn't always been easy. many soldiers have lost their lives, including nine estonians in afghanistan. nato has proven that it is able and willing to adapt to reform and prove that it is still multinational command structure relevant. nato has been an adaptable organization. decisions made during different rounds of enlargement are proof of that. the risk to take and seven more eastern european countries a

decade ago turned out to be a worthy one. the security of the planning community has improved through enlargement of nato. however, we cannot take this achievement for granted. security needs constant commitment and improvements, especially in the unpredictable and complex world. nato has to remain active and find ways to engage more. at the summit in the coming months, we must confirm that we value contribution and we remain open to new members.

this is not a consensus understanding today. we should encourage and help countries so that they can prepare better for the next membership. we wish to see, among the conclusions of the nato summit, a recommitment to the two percent spending principle. today, five countries out of 28 spend less than 1% of the gdp to defense. only five spend more than 175 -- 1.75%. only four countries crossed the 2% threshold. in the 1990's, it was 12. months, we must confirm that we if the negative defense spending trend continued, nato's military capabilities and political credibility could be put at

risk. it seems as we are outraged by the cost of war, but we are more outraged by the cost of peace. we should not consider europe as one homogeneous area, but that all the countries think and act at the same time. estonia is one of the countries that understands the necessity to continue to contribute 2% of gdp to defense and who actually does so. when i became minister in 2012, it was the first year that we contributed 2%. we will remain at that level. the biggest difficulty is to sustain that level when many others do not respect their commitment. it is of utmost importance that the nato summit reaffirm the 2%.

we need to keep this as a goal. stating this goal will not instantly changed the defense budgets in europe. if it is vice versa, it will lose that bit -- that benchmark and will bring additional cost. at the summit, nato must reconfirm its commitment to --. both article five and -- article. the baltic region is the only one in nato or the military's strategic balance is not favor the allies. because of our good friend, russia. nato must continue to ensure no outside powers tempted into making a miscalculation.

the good work we have done in demonstrating political unity and decisiveness must continue. contingency planning and conducting exercises on a regular basis, second, sending an ambitious, clear, and an ambitious, clear, and consistent message to third parties. . . sending an ambitious, clear, and consistent message to third parties. both contingency planning and exercises should be a normal and routine part of nato's work. third, the continued stance of the transatlantic link is also one of the main topics of the summit for us. we wish to see the u.s. committed to europe and the european allies committed to a

fairer burden sharing. europe a challenge for and we will remain to arise the question among our european allies. burdens a question of sharing inside europe that needs to be addressed. many are frustrated with european level of distance -- of disp >> willingness to take part in military operations.

>> i still have to underline the importance of american presence and visibility. betweenn forces nato's credibility. in times of defense, having reliable allies willing to share the burden of collective defense becomes even more important. this seems to be commonly ignored. according to the survey transatlantic trends 2013, only 15% of americans felt that nato

helps country share the cost of military action. only 12% of europeans say the same. this means there is a lot of room for improvement. gentlemen, we have run out of money and now we have to think. offices of the free country aren trained in the one single institution, since 1919. we have a joint system and common mind unit. in 2016, we will send board

battalion to the nato responsect force. our region is larger than board state. finland, ireland. we also coordinate international military operations. we take part of -- once the

mission comes to send. alliance is currently at the pinnacle of our intercollectiveness. the glue will start to unstuck. it is also important politically as it demonstrates nato's continued relevance. therefore, the connected forces and initiative is one of thefo corerc issues for estonia. we hope to see forward looking deficit program annual liven exercises put in place. these exercises should take place all over the alliance on both sides of the atlantic.

to say few words about the latest nato exercises, in november -- took place in poland and board of state. sent as a scenario, the defense of estonia by the alliance nato headquarters prepared for that for more than a year. bee as a result, now we are muchea better acquainted with our

region and security challenges. nato headquarters opportunities to exercise. in a collective defense scenario. what we f learned is that our lg engagement in counterterrorism type wars has changed our mindset. it really has driven us away from the collective defense approach. the second was poland who contributed 1000 troops and bronze medal, same level was to

the u.s. and estonia. both contributed. ied don't think this operation - it was honor for us to host estonian defense exercise. it was the first time this exercise took place outside ofii shape. 400 people in 32 different countries and it was a success. we hope to continue to host exercises in estonia with training and education and also nato's capability to develop. we have gained a lot of experience. estonia is a country -- of every

single conflict. workinge, we are closely with our allies to improve states national cyber defense capabilities. long military engagement has given us more than just interoperability. they have given us a trustful relationship. trust and relationships take many years to build.la person ttio person connections only available because you have gone to school together because you have endured hardships together. you highly value the relationship have been with u.s.

on the field of afghanistan anda iraq. nothing can replace experience side by side. we wish to maintain this linkths after the end of karzai mission and to find more openings for operation. to sum it all up and in attention of your questions -- first collective defense and nt thirded incorporate security. we don't see a need to make revolutionary reforms but rather just focus on nato and improve national contributors. despite the pessimism about the

ultimate success of the natoout mission in afghanistan and continue to debate about the contributions to allied burden sharing, 55% of americans and 58% of europeans see nato as essential for their country security according last year's study. nato's main value was to be alliance of democratic countriel that should act together. it means there is a lot worth preserving. thank you very much. >> thank you very much for that both thorough speech and but also very provocative talk. there's a lot here for us to dug

into. first i think of the comments you made i was struck by was the recommitment to the metric.ric. which is something we struggled with in the alliance for some time as you rightly point out the statistics on that. i think the real question though for us have to be how can we bev persuasive on this? if we use your thought that without having it, we might be in more of a free-fall than with having it. what do you think can most persuade those countries aren't currently making the two percent in the absence of an overwhelming threat. let's assume that might be persuasive and sense of an overwhelming threat. what do you think those of us e making the mark can do to be persuasive to other countries? >> i will try to avoid to be

provocative. >> provocative is a good thing.i >> nots in antarctica. i think what is most important is actually to applaud the success stories. i'm trying to tie mostly nato and european union here saying, okay, we have like -- we try to balance during the turmoil of financial crises of our national budget or we have to make cuts to defense. estonia has proven it is possible to do them both. these are not contradictory aims. we do have a balanced budget. our structure budget is balanced. we do have smaller national debt in the e.u. we have been succeeded to move

against the tied in europe, which means during the times when -- if i fellow partners and countries are doing cuts to thec defense spending, we are doinge vice versa. we are recruiting more men and c women to the army. we are buying new weaponry, etcetera. of course, we are not doing itn. for just for fun. but this is our view of security that also small country needs to be net provider of the security. this should be a cornerstone of the way to show also european allies the way forward. the second, i think, where clear and sound message what the u.s. has given. secretary hagel very clearly put

to the message that europe has to understand that this will not be sustainable that domestic scene in u.s. will one day just block it because of the viewpoint of fairness. we are european alñies together have to understand it and not to turn to the nato, such a nega negative scenario. those are the cornerstones now. >> that brings to mind smart defense and how countries can contribute and nordic state had this great example.at l what lessons do you think that nordic cooperation -- what lessons can that provide to ot$er states in europe who areei looking at smart defense

approach? >> to be honest, i'mre a little bit worried about the over using the word smart defense in a way of excusing the defense cuts. how much money we put in but we work on the list of outputs. that is something which is als (áájjáñ heard. from the zero you count to positive thing, which is self-evident. the smart defense i think were good example of smart defense from all regions indeed, a permanent policing over the skyt i'm hap(y to inform you that from last friday, the u.s. pilots, u.s. planes are now pla taking care of their duty to

defend. i'm very positive also about the security and defense i mentioned of the european union where i think the joint procurements and also programs of developing certain new security assistance have turned to be a successfuln. one. >> you mentioned the u.s. air force participation in the balti air police. you spoke with the last u.s. tank leaving europe. what do you think are the most critical u.s. capabilities for

defense of european territory? what can u.s. focus itself on if it needs to focus in terms of providing capabilities forward into europe? what makes the most impact witht you and with your public? >> i think in our region is a like a special area of the a europe.se w we are indeed the only area of capabilities have minority of different actions which could be labeled as a presence. this is exercises. this is indeed very clear andpoi

sound political statements when they are needed. i would be most pleased to see permanent u.s. presence in my homeland. i understand the realities today. border countries are a special case and as much as presence if u.s. could produce. i think as efficient it will be also to encourage european countries to fulfill their responsibility. in a way, if the u.s. domestic

seen looks at european countries. european countries look okay, they are moving towards pacific. this is something we have to avoid to both ships are going like far away from each other. >> what is your sense of the u.s. rebalance approach and howa it's being received in year and -- europe and how u.s. spoken t. europe about its strategy? worrisome? is it understandable? >> actually u.s. takes seriousl the need to explain what their agenda is. secretary hagel has given a

worry -- surely, especially eastern european countries of u. s. -- showed actor in the area will be consistent one. i think surely we understand the financial challenges also and the u.s. army reform. presence can be i produced in te most cost efficient way especially in our region as we see. it would be very much appreciated coming times will bo

-- >> let me open it up to the audience. we have a few folks with microphones who can come around when i call you, if you could tell us your name and h affiliation. >> pastor rick, renaissance institute. i've watched nato from the beginning. in my thinking, i managed to divide it into two organizations. i call them micro and macro. the first micro nato would have been the one that existed for the first 40 years you talked about. when there was no fighting done, etcetera. no war or whatever. the macro one has been when this expansion started to take place when we started to bring people in or tried to from 1500 miles

away from the north atlantic.not it appears from an outsider standpoint, that macro nato hasn become more or less an antagonist or an aggressor.e is that somean of the reason you think some people have started to back away? am i correct? i may not be. >> i'm proud you have mentioned the nato since the beginning. althou years. i would just tell my country's viewpoint on internationalssio missions. when an estonia, we explain to the public why we are abroad, why we send our boys and women to the afghanistan to iraq and

to africa, why we're doing it. we are saying, we are doing in the sake of the liberty of our country. they are defending the liberty of our country there.r co they are doing it so that the most practical way in the modern world is to solve the crisis in the area where the crises occurs. if the crises will rise bigger and bigger, it will also put to the handcuffs, the nato and all the allies to act.nd t this is something i will not take the position to say, something like we see as a nato as an aggressor. we in all cases know the

humanitarian need and the democratic values why the nato acts in different scenarios. those are for justified to my understanding of the principals of liberty, dignity of humans and humanitarian raises. >> all the way in the back on the other side. >> steven blank, american foreign policy council.her you mentioned that the balti is the only region in europe where nato suffers from minority position that the balance is against nato thanks to russia.es in which ways does the balance work on behalf of russia and against nato? >> i would just mention some

figures which show that a certain balance or the security in our region is like turning . it has turned and therefore not in favor of the nato allies in , the region. i if we -- if i say state two part about 6000 nato troops was the biggest article scenario exercise after the cold war.

so was 2013 was also the biggest, i would say, aggressive scenario based towards west exercise after the cold war where we estimate took part both reserve troops and all together about 100,000 troops. there are lists of different activities from the russian sidc what we see in a historical sense. in the western i mentioned, western military region and russia, this is one of the priority regions of russia to invest in defense. in addition to that, it has been

turned priority in a future way. danger or not, this is a political question brought from the military viewpoint, we understand the balance is turning not in favor of nato in our region. this is a reality we face. thank you. >> erik, at the friends committee on national legislation. when you mentioned the things united states can do to ensure the u.s.'s comment to nato, i thought it was interesting youer didn't mention the president of the united states tactical nuclear weapons. with the end of the cold war and declining the defense budgets both here and nato states, do

you think nato can adapt its nuclear sharing arrangements with the united states. what's the steps could the u.s. take to ensure nato security without the presence of nuclear weapons in europe? >> i would say -- the nuclear weaponry and also about the bal nuclear power balance. also looking to the tactical nuclear weapons. nuclear deterrence is badly needed i think for the nato. if i didn't mention it in my speech, i will do it now.

the reality is also that nuclear weaponry is rarely clear seen in the russian federations defenser strategy. where they say that -- there h's been comments in the u.s. fights against, or once diminish nuclear weaponry, it's only because of in an order in weaponry. we have more power. realities that russian federation looking from our region's viewpoint, we have

nuclear weaponry in strategic military thinking using the tactical nuclear weapons. this is something we are aware. >> the evolution of russian military doctrine seeming to be moving more into even morenucl nuclear dependence approach. how do you think, particularly given where you are in the region, what are the mostre worrisome trends, in terms of russian military thinking in general. what worries you the most? >> i think something -- i willf

say that danger of the military actions of major conflict in our region is very low today.is t a reality is that what we see problematic is that in russian strategic -- strategical thinking to achieve political aims and help military means is quite justified. secondly, for their military thinking, the main danger is actually a military attack from the west side from the nato side to russian side. this is surely a second one and

thirdly, i think the problem is lack of transparency i think in their way of thinking, in the way of decision-making and inon the way of what they would achieve in the global politics. when i mentioned that in our region, the military balance iss minor or negative towards nato compared to russian federation troops. could also -- it could produce also the situations where danger of situation -- not because of problems between russia and estonia, because it

is a area where it could be wou easiest to just take -- to rebalance in the situation. far away there appears a conflict between the russian federation and u.s. or nato. there's something very interesting also in russia tv, they started public discussions. there was discussions about whether u.s. was going to send m the missiles. russia is in discussion. should we take the balance -- the situation should also take prospect from estonians.

intriguing for us. >> i'm bob former state department official. i wanted to ask you, you touched briefly on european security and defense policy. i wanted to ask you perhaps expand a little bit on that. how you see assess espd, particularly the question of whether esbt is resulting inres duplicate structures. the duplicate will exist in nato. perhaps is not a wise thing. >> it is surely an issue which has now a discussion in the european union. the european heads of statesecem

discussed it last september. i was satisfied because it gave a signal that from the european union, the corporation with nato is needed not i think as strongly i would be applaud, at least it was fixed. secondly, it gave very clear signal that european union is going to work on the military capabilities. thirdly, i think the minority of the countries are the same which belongs to the nato and european union. i would be very logical not to duplicate but to standardize different actions. for us is very logical if we'rer speaking on defense.

level of cyber defense of the european union institutions and european countries and nato institutions, nato headquarters be the same. it is a cheaper in the case of major crisis u.k. is clearly of very strong. not european union not to develop too far. it's military security a cooperation. now it's b finding a balance. we have to step forward and that's something positive. >> we have time for two more. >> i wanted to ask you about your thoughts on the recentyour failure to engage with theilur

ukraine on the part of the ain european union. >> i remember for estonia for eastern european countries to g, west, it's a momentum for end of 1990's. i think now sending a strong message to his words. an idea of looking also those countries, and eastern european countries. possibility to choose their own

part is between the two.do the one is indeed an interest -- [inaudible]. another is a european values and western values. ukrainian situation very clear. i think we understand unfortunately what putin wants t to build.new the new block of countries where where strategic role surely plays ukraine. they are using all the means to

achieve that aim. i think what is very important that the western leaders and also the public audience should send a very clear message. the first message is indeed to kremlin. it is unacceptable to influence the independent countries toe make the options about theak countriees and nation's future. the secon" is also -- that is unacceptable to use violence. this is the message we need to be giving to the government. i'm not very optimistic about the coming weeks and months

outcomes. the position is also fragmented. you have to be always careful with red lines where you put it. opposition has put several red lines.

>> different question would be the culture is not in case where europe, the union of values who could take one country just onpn the principles of money or the need of money. this is not just a marketplace but this is a union of values, europe. this is fatal mistake gorbachev has made. >> final question. >> john with b.a.e. systems. appreciate a your comments on prescriptions for nato looking forward to it. i'm curious if you can elaborate

on your own domestic prioritiesh you noted cyber is increasinglyv important. i'm curious if you can elaborate on your own capability priorityu >> our military capability priority.r it is the most important is rapid reaction capability from us. we need to be ready to act. also to give our allies a chanc when collective defense model with the chance to make

logistical movements. we in estonia, as we are moving against the tied investing into defense. there's also one element where i think we are in the modern world in a minority group of gly countries. we in estonia believe in national prescription system.co after we joined nato, there was discussions whether it was practical to continue. 90% of estonians support it, not because it's most cost efficient way we can hold a reserve army. but because there's also strong dimension that free men are taking the duty to defend their country. this is something very important

to estonians. p our plan is to establish 21,000 rapid reaction troops army. if we touch the button within very short time frame, we will have such an army. it was based on the reserves. thank you. >> well, thank you very much for covering such a great amount of ground with us today for your talk and for your interaction and also for the great partnership and alliance we havu with estonia. ofase join me in round applause.

>> i was very privileged to be here. i'm very happy to see you here also. thank you very much.uc >> vote is under way to whether to confirm janet yellen. she's been vice chairman of the fed since 2010. if confirmed will succeed ben bernanke. the mixed vote in the chamber, the deal is whether to move forward on extending unem0=e5q benefits for the long term unemployed. of the associated press, whereas

democratic supporters of the three month extension of jobless benefits say they were close to 60 votes needed to advance the bill. their chances, four republicp's in addition to senator dean hellq) of nevada. the measure would restore benefits to about 1.3 million people affected when the program expired december 28th. unemployment insurance, payments average about $256 a week. you can see all of our senate coverages live on c-span two. >> we focus on the issues. we are focused laser like on innovation. we want to make sure innovation is a national strategy and american companies could keep introducing the greatest products in the world. we dominate in areas. first we have a lot of multiinternationals. it's a global phenomenon

innovation. u.s. is the world leader and we want to keep it that way. it requires rationale patent policy. you can invent -- >> the head of the consumer electronic association gary shapiro tonight on the communicatetors on 8:00 p.m. eastern on c-span two. >> as part of our series first ladies, c-span spoke with rosalynn carter, first lady from 1977 to 1981. we stalked with steve ford, who proceeded mrs. carter as first lady. you can see first ladies tonight here on c-span. >> you're watching c-span two with politics and public affairs weekdays featuring live coverage of the u.s. senate on week nights watch key public policy events and every weekend the

latest nonfiction authors and books on book tv. you can see past programs on our website, you can join on the conversation on social media sites. >> medicare and medicaid officials say last year saw the lowest health insurance premium increases since 1986. the announcement came today at an event hosted by the journal health affairs. the national press club in washington, this is almost an hour. >> good morning. i'm founding editor of health affairs. i will moderate a discussion this morning. i appreciate you all coming out on this day of warm weather before we all freeze tomorrow. it's a pleasure to have the staff of the office here to present. we'll have two presenters and then two others i'll introduce

all four here in a minute. i'm prepared to help answer questions, respond to opinions, whatever it may be. i also point out in here is not only the expanding paper, its a cd that has the whole of the content of new issue of health affairs in it including the exhibits if anybody is in the exhibit. look for this to have everything you'll need in relation to at least the subject that we're talking about this morning and also the entire contents of the january issue. for about 25 years now, health affairs has been publishing every year the annual report of the office of the actuary that

relates to national health expenditure trends. obviously, the latest report which you'll hear about and many of you have read in the terms of our paper, relates to 2012. over this time of this long stretch of time, at least we've been publishing the subject, healthcare spending has averaged annually about 2.3 percentage points greater than the growth of the national economy in that particular year. while that percentage may sound modest, it's really largely the reason that healthcare expenditures have continued to gobble up more of the nation's economy every year. growing from about 5% in 1960 to

17.2% in 2012. we'll hear more about that from our presenter. today story obviously is different. somewhat of a surprise you might say. i don't think there's any agreement either in the actuary and other government circles. the reasons why obviously the recession played a part in it. the a.c.a. provisions probably played little or no part in it in terms of 2012. we'll hear more about that from the presenters. it's a great pleasure to introduce ann martin who will lead off. in the office of the actuary. she will be followed by michael

hartman who is a statistician. he's a national health statistics troup. two of the individuals here that will be available to answer question or help answer questions or respond to opinions, whatever. lekha whittle who is the econosráu in the office of the actuary. >> thank you very much. is this how i operate this? okay. good morning, thank you all for

coming today. my name is anne martin. i'm here today with other members of the national health expenditure accounts team to present to you the results of our national spending article for 2012. the trends that we will discuss today highlights some of the important points contained in our article which is to be published in the january edition of health affairs. just a couple reminders, the information that we're presenting here today is embargoed until 4:00 p.m. at that time, the entire historical data series will be available on our website. i'll start off with main points of the 2012 report. national health expenditures increased 3.7% in 2012 compared to 3.6% in 2011.

total health spending reached $2.8 trillion, where $8915 per person. health spending is a share of over all economic output as measured by gross domestic product fell from 17.3% share in 2011 to 17.2% share in 2012. i like to point out that in july of 2013, there was a substantial upward revision of gross domestic product. this caused health spending share of gdp to be lower than it would have been had there not been a revision to gdp. this affected all years back to 1960. on this graph, what we're showing the annual rate of growth of national health expenditures compared to over

all economic growth as measured by the gross domestic product. we're showing national health spend as a share of gross domestic product. there's three vertical bars and those indicate the last three recessions. what we can see in this illustration is that during the last three recessions, health spending growth was faster than that of gdp. at the same time, the health spending share of gdp increased. because health spending growth is usually faster than over all economic growth during recessions, health spending takes up a larger part of the economy. however, soon after the end of each recession, gdp growth begins to pick up and growth in health spending starts to slow. we refer to this as lag impact of recession. from 2010 through 2012, this lag impact is illustrated as health spending share of gdp was relatively stable between 17.2

and 17.4%. i will now walk through some of our high level trends. they are relatively steal health spending growth rate from 3.7% in 2012 following growth of 3.6% in 2011. not due to one prominent trend. it was due to mixed trends within services and payers. for personal healthcare spending which accounts for 85% of over all national health spending, growth accelerated in 2012 increasing 3.9% compared to 3.6% growth in 2011. however partially offsetting the faster growth in personal healthcare spending with slower growth in investment and health related equipment and net cost of private health insurance. this was accompanied by a decline in noncommercial research that was due to the expiration of funding from the american recovery and

reinvestment act of 2009. we can attempt to explain how spending growth by examining components related to price and nonprice factors. prices increased at a slower rate and accounted for smaller proportion of health increase in 2012 compared to 2011. nonprice factors refer to population growth, the age and gender mix of the population and all other factors such as the use and websitety of -- intensity services. this graph illustrates how we analyze the price and nonprice factors. the gold line is a

representation of per capita spending growth from 2008 through 2012 for both aggregate national health expenditure and the sub component personal healthcare. the blue section of each graph represents the portion of per capita spending growth due to growth and medical prices which includes over all economy wide inflation and medical specific inflation. the red section represents the age and gender mix of the population. the green section represents all other nonprice factors such as use and intensity. here we can see the effect of growth in each of these components relative to total growth. as i previously said, medical prices increased at a slower rate as compared to 2011. because health spending growth was relatively stable, prices accounted for a smaller proportion of per capita health spending growth. some specific reasons for this which are mentioned again later pertaining to services and payers, includes swelling of

prescription drug prices bras of the -- because of wave of blockbuster patents at the end of 2011 and 2012 which led to lower prices for previously expensive drugs. there's a rate adjustment for medicare skilled nursing facilities which reduced payments for 2012. also, there were reduced payment updates for most medicare providers resulting from productivity adjustment, mandated by the affordable care act. for healthcare services our main finding included faster growth in hospitals, and slower growth in prescription drug and nursing care facility spending. for healthcare payers be, we saw faster groi in medicaid and out of